The authors from the University of Arizona and the National Pharmaceutical Council invited pharmacists and physicians employed by managed care organizations, pharmacy benefit managers, healthcare systems, and government agencies to participate in a two-phase investigation: 1) an online survey that evaluated the potential use of sample RWE studies published in top-tier journals in payer decision making, and 2) focus groups or telephone interviews on attitudes and use of RWE in general.

When asked whether observational studies play a role in their organization’s medication use policies, participants responded 11% “almost never,” 79% “sometimes,” 5% “often,” and 5% “almost always.” Responses further showed that while nearly all participants indicated that RWE is useful for monitoring safety, conducting utilization management, and examining costs, it is less likely to be considered in P&T decision making.

Key concerns with the use of RWE in payer decision making include relevance to payers, timeliness, and transparency of methods. Specifically, timeliness of study results was rated as one of the greatest personal and organizational barriers to using RWE. Most health plans have compressed evaluation periods because of the 90-day review mandated for Medicare Part D and Medicare Advantage programs, but RWE studies are typically generated after product launch and after decisions for coverage and reimbursement have already been made. Participants recognized the need for continuing education on evaluating and using RWE to better understand the study methods, findings, and applicability to their organizations.

“Heretofore, little has been known about how managed care organizations use real-world evidence in their formulary, utilization management, drug monographs, and other decision-making processes,” said lead author Daniel Malone, PhD, University of Arizona, Tucson, AZ, USA. “This study provides new insight that can be used to improve both the quantity and quality of real-world evidence as it is applied to the healthcare decision making process.”

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